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What to Know About Medicare Benefits for Preventive Services

Along with exercising, eating well, keeping a healthy weight, and not smoking, you can support a healthy lifestyle by taking advantage of preventive health care services.

This is true for people enrolled in Medicare too. Medicare enrollees are entitled to an annual “Wellness Visit” with their primary care team to discuss what they can do to stay healthy and prevent future illnesses.

Medicare-covered services can include exams, certain vaccinations, lab tests, and screenings, along with programs for health monitoring, counseling, and education. These are great benefits – and your annual Wellness Visit can make sure you put them to good use.

‘Welcome to Medicare’ Preventive Visit

There are two different “preventive care” visits covered by Medicare. The first one is called “Welcome to Medicare” and occurs within 12 months of enrolling in Medicare’s Part B coverage.

This visit is an opportunity to get up-to-date on important screenings and immunizations, update your primary care team on any changes in your family history, and get important tips for staying healthy. Depending on your health and family history, your primary care team will provide recommendations that meet your specific needs.

At the end of your visit, you’ll receive a written plan (like a checklist) providing an overview of screenings, immunizations, and other preventive services you may need. If you have any health risks, you may receive a referral to have additional tests or screenings performed.

As an example, if people in your family have had abdominal aortic aneurysms (weakened areas in the main vessel supplying blood to your body) or if you’re a man between the ages of 65 and 75 who has smoked at least 100 cigarettes in your lifetime, you have a higher risk for a blood vessel rupture. As a result, you may be referred for a one-time ultrasound screening. If you fall into a high-risk category, you’ll pay nothing for this screening.

Once you’ve completed your welcome visit, you must wait at least 11 months before you can start your subsequent Annual Wellness Visits – something you should take advantage of each year.

Yearly Wellness Visits

If you didn’t take advantage of your “Welcome to Medicare” visit, but you have been covered by Medicare Part B for more than 12 months, you’re entitled to an Annual Wellness Visit. This visit is your chance to develop or update your personal health plan with your primary care team.

The visit will usually cover:

  • A review of your medical and family history
  • Developing or updating a list of current providers and prescriptions
  • Height, weight, blood pressure, and other routine measurements
  • Detection of any cognitive impairment
  • Personalized health advice
  • A list of personalized risk factors and treatment options
  • A screening schedule (like a checklist) for appropriate preventive services

What Does it Cost?

There is no out-of-pocket expense for the “Welcome to Medicare” preventive visit or the Annual Wellness Visit if your doctor or other qualified health care provider accepts Medicare-approved cost as full payment.

It’s important to note that the Medicare Part B deductible does not apply to Wellness Visits.

If tests or services are performed during your Wellness Visit that are not covered under Medicare’s preventive benefits, there may be a co-pay and the Part B deductible may apply.

Meet the Author

Jeffrey K. Bahr, MD is board-certified in Internal Medicine at Aurora Health Care in Milwaukee, Wisconsin. He also serves as the co-chair of the new system-wide Department of Primary Care across all of Aurora Health Care.

Read more posts from this author

The information presented in this site is intended for general information and educational purposes. It is not intended to replace the advice of your own physician. Contact your physician if you believe you have a health problem.

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